Die Diametaphysäre Radiusfraktur im Kindes- und Jugendalter

A.Herzog, P.SchmittenbecherStädtisches Klinikum Karlsruhe, Karlsruhe

Einleitung

The optimal therapeutic strategy of the distal radial metaphyseal-diaphyseal junction fracture, especially the impact of osteosynthesis, has always been involved in heated debates in the field of pediatric trauma surgery. Due to its unique location, there is a key argument against a surgical approach involving the application of osteosynthesis: the distal fragment of the fracture is considered to be too long to be stabilized by Kirschner wire (K-wire) while too short to be stabilized by elastic stable intramedullary nailing (ESIN). The opposite non-surgical approach is the immobilization through the application of an orthopedic cast, either with or without an adjuvant reduction. While there are currently no official recommendations on this issue, the purpose of this retrospective review is to evaluate the midterm outcomes of the different treatment options that are commonly applied.

Material und Methoden

We have reviewed 30 cases involving traumatic, non-pathological fractures occurring within the metaphyseal-diaphyseal junction zone treated in our department between 2012 and 2016. All cases were concluded at the time this study was conducted. The demographics of the study cohort spread between 1.6 and 15.8 years of age (9.1 ± 3.6) with an angulation between 44 degrees towards volar and 41 degrees towards dorsal (17 ± 12.5). 25 cases were initially treated non-surgically through immobilization either with or without an adjuvant reduction. The other five cases were primarily managed surgically with osteosynthesis accompanied by intraoperative reduction.

Ergebnisse

Within the sub-cohort that received surgical treatment, three cases were treated with ESIN, one with K-wire, and one with plate. All five cases were concluded without any prolonged functional limitations or subjective discomforts after the implant-removal. The duration of the total follow-up period lasted between 9.4 to 38.6 weeks (23.9 ± 9.6), depending on the method of osteosynthesis.

Within the sub-cohort that initially treated non-surgically, two cases (8%) of re-fracture occurred within two months after consolidation and one case (4%) of secondary dislocation occurred before consolidation. Both re-fracture cases were ultimately treated surgically with osteosynthesis, one with ESIN and the other one with K-wire, whereas the case of secondary dislocation underwent reduction under general anesthesia and continued with its initial non-surgical treatment through immobilization. The duration of the total follow-up period lasted between 2.9 and 30.4 weeks (9.5 ± 9.2), dependent upon whether complications occurred after consolidation. Two cases (8%) presented functional limitations after consolidation: one with limited supination, the other one with limited pronation. Another two cases (8%) displayed subjective discomfort due to temporary deformation from dorsal deviation of the initially fractured distal fragment. All four aforementioned midterm complications diminished spontaneously within six months after consolidation without further intervention.

Schlussfolgerung

In conclusion, both surgical and non-surgical approaches have been proven to be valid as treatment options for the distal radial metaphyseal-diaphyseal junction fracture in children and adolescents.

The midterm outcome of both methods displays no significant difference. The risk of traumatic re-fracture has been generally believed to exist under both therapeutic strategies. Temporary functional limitations or subjective discomforts usually diminish spontaneously within a reasonable time frame.